INSIDE

2 4 6 8Health & Wellness in Children Intravenous Pyelogram (IVP) Adolescent VaccinesWhat’s New?

NLC Raising DayContinuing to learn

1 3 5 7NLC GH observes Nurses DayAnaesthesia and Hypothyroidism 10 Health Tips to live Hundred Years

Nutrition in PregnancyHealth & Wellness in Children(Contd...)

Vol. VII Issue I July 2015

LIGNITE LIFE LINEPROVEN VALUES. POWERFUL VISION.

NLC GH observes Nurses Day

Nurse’s day was celebrated on 27.05.2015 at N.L.C G.H Commemorating the birth anniversary of Florence Nightingale. The function was presided over by Dr.K.Janardhan, C.G.S/Medical, Dr.P.Ravi, G.S/Medical, Dr.V.Nagaraju, G.S/Medical & Dr.M.Malarvizhi, C.M.O (Nurses incharge).

Our Nursing Superintendent Smt. D.Santha, delivered welcome address, Smt.T.Arputham Tamil Selvi, Deputy Nursing Superintendent, spoke about the Top Ten qualities of Best Nurse. Our C.G.S/Medical, Dr.K.Janardhan addressed the gathering on the techniques of hand washing.

The celebration came to an end with a tremendous yoga demonstration by yogasana team & cultural programme by our tiny tots.

Yoga Demonstration by Yogasana team

Dr.K.Janardhan's (CGS Medical) spoke about the techniques of hand washing.

Smt.T.Arputham Tamil Selvi, Deputy Nur.Supdt., spoke about the Top Ten qualities of Best Nurse.

Nurses Day Oath taken by Nurses

2

Dr. R.Arulmozhi Department of Peadiatrics

Health & Wellness in Children

This topic focuses on the concept of wellness and

maintenance of health with respect to feeding, exercise and

prevention of diseases.

Motherhood

“The moment a child is born, the mother is also born. She

never existed before. The woman existed, but the mother,

never. A mother is something absolutely new”.

To maintain wellness in the child it is essential that the mother

is happy and well looked after by her spouse. The mother

because of her biological attachment to the child is

responsible to inculcate habits that are healthy and ought to be

well versed with prevention aspects of child care.

Newborn Care

A newborn baby has only three demands. They are warmth in

the arms of its mother, food from her breasts, and security in

the knowledge of her presence. Breast feeding satisfies all

three

Breast feeding

The best tailor made nutrition for the newborn baby is breast

milk. No other food stuff can match its quality and provide a

similar set of nutrients to the baby. Breast milk is provided by

nature so that the mother can take care of the baby all by

herself. Breast feeding is a right of every mother. It is not only

the responsibility of every mother but also it is the source of

pride to her. It completes the role of motherhood. To

understand that the baby is capable of growing to its full

potential only through breast feeding is all the more fulfilling for

any mother.

Weaning

Weaning is a process where the baby is given food stuffs other

than breast milk. This gives time for the baby to look around

while feeding. By six months babies are able to sit with or

without support which enables feeding with semisolids or soft

solids with a teaspoon. In addition to weaning foods it is

essential the mother continues to breast feed the baby. This

maintains the bonding with the mother and at the same time

gives freedom for each other. Home made preparation like rice

kanji, ragi kanji, idli, dhal rice, fruits, vegetables, egg etc., are

good and help the child to grow in a healthier way. Though

there is distance from the mother in actual terms while feeding

with a teaspoon, the mother can establish a new emotional

bonding as the babies are communicable now. The babies

show avid interest in tasting new stuffs and the baby

associates emotions to the feeding time. The objective of

weaning should be that we as parents must make the baby

enjoy the meal time.

When children show resistance to feeding, a permissive

parent tries to offer foods that are not allowed or that are not

nutritious only to keep themselves away from the guilt of not

feeding the child. Thus the early seeds of junk food eating are

sown into the child's mind.

Nutrition

Basic nutrients should be taken along with a lot of roughage.

Food should be taken as a source of energy. Eating should not

become a pass time. It should not become a substitute for

positive emotions.

Contd...

Breakfast is a very important meal. A good breakfast fuels the

child up (after going without food for 8 to 12 hours during sleep)

and gets the child ready for the day. In general, kids who eat

breakfast have more energy, do better in school, and eat

healthier throughout the day. Without breakfast, kids can get

irritable, restless, and tired as their mood and energy drop by

midmorning.

Breakfast also can help keep kids' weight in check, have lower

blood cholesterol levels and fewer absences from school.

Breakfast kick-starts the body's metabolism and when the

metabolism gets moving, the body starts burning calories.

Those who do not eat breakfast tend to consume more

calories throughout the day and are more likely to be

overweight because they are famished before lunch time and

snack on high – calorie foods or overeat at lunch. Inclusion of a

good breakfast is highly influenced by parental role modeling.

It is necessary that the family waking time has to be advanced

at least by 10 minutes to ensure allocation of time to feed the

breakfast that is ready. It can be anything as long as it has all

the essential nutrients along with milk and fruits and

vegetables.

Parents should inculcate healthy eating habits in children by

role modeling and not by disciplining. Only nutritious food

stuffs should be prepared at

home. Junk foods should not

be permitted in the household

and no adult should be seen

enjoying the same.

Vaccination

Children should be vaccinated

against vaccine preventable diseases. Vaccines have

reduced the mortality due to Measles to a large extent.

Vaccines are stored at specific temperatures and the cold

chain is maintained from the manufacturer to the end user; that

is the child. Potency of the vaccine can be affected if adequate

precautions to maintain cold chain are not taken.

Play

Play is an essential activity for all children. Not only is it

enjoyable but it also makes an invaluable contribution to

children's educational and social development. Parents

should again be role models. Parents who are laid back and

lethargic tend to have signs of

adult onset diseases very early

in their lives. Children who are

glued to screens as in

Television or computer usage

tend to be obese as there is no

scope for spending the calories taken.

Exercises

Exercises improves the circulation of blood to tissues thus not

only helping in healthy regeneration of tissues but also in the

healthy removal of waste end products from all tissues in the

body. Exercises thus enhance the internal environment well.

Parents will have to bring a change in the family diet from today

as waiting for tomorrow does not give us a deadline to begin

our transformed life style.

Safe Environment

Parents should teach their children about personnel safety at

home and school etc.

Health and Wellness in children depends on :

n Proper mother care during pregnancy

n Hospital delivery

n Proper new born care

n Exclusive breast feeding for the first six months

n Weaning foods (Home made preparations) & breast

feeding after six months

n All vaccines should be given as per immunization

schedule

n Allow your child to play & to do physical exercise daily

n Safe environment at home and school

n Not skipping morning breakfast

n Avoiding junk foods usage in children

3

Contd...

4

What is an Intravenous Pyelogram (IVP)?

An intravenous pyelogram (IVP) is an x-ray examination

of the kidneys, ureters and urinary bladder that uses

iodinated contrast material injected into veins.

When a contrast material is injected into a vein in the

patient's arm, it travels through the blood stream and

collects in the kidneys and urinary tract, turning these

areas bright white on the x-ray images. An IVP allows the

radiologist to view and assess the anatomy and function

of the kidneys, ureters and the bladder.

What are some common uses of the procedure?

The IVP exam can enable the radiologist to detect

problems within the urinary tract resulting from:

n kidney stones

n enlarged prostate

n tumors in the kidney, ureters or urinary bladder

n surgery on the urinary tract

n congenital anomalies of the urinary tract

How should I prepare?

You will likely be instructed not to eat or drink after

midnight on the night before your procedure. You may

also be asked to take a mild laxative (in either pill or liquid

form), or enema the evening before the procedure.

You should inform your physician of any medications

being taken and if there are any allergies, especially to

iodinated contrast materials. Also inform your doctor

about recent illnesses or other medical conditions.

You may be asked to remove some or all of your clothes

and to wear a gown during the procedure. You may also

be asked to remove jewelry, removable dental

appliances, eye glasses and any metal objects or

clothing that might interfere with the x-ray images.

How is the procedure performed?

You will lie on the table and still x-ray images are taken.

The contrast material is then injected, usually in a vein in

your arm, followed by additional still images.

The number of images taken depends on the reason for

the examination and your anatomy.

An IVP study is usually completed within an hour.

However, because some kidneys function at a slower

rate, the procedure may last up to four hours.

What will I experience during and after the

procedure?

The IVP is usually a relatively comfortable procedure.

You will feel a minor sting as the contrast material is

injected into your arm through a small needle. Some

patients experience a flush of warmth, a mild itching

sensation and a metallic taste in their mouth as it begins

to circulate throughout their body. These common side

effects usually disappear within a minute or two and are

harmless. Rarely, some patients will experience an

allergic reaction.

REF: RADIOLOGY.ORG

Dr. Anjugam Department of Radiology

Intravenous Pyelogram (IVP)

5

One in two hundred people has hypothyroidism in adult population. Hypothyroidism Is due to decreased function of Thyroid Gland and reduced release of thyroid hormones. Thyroid Gland is situated in the front of the middle of neck. It is butterfly in shape and 30 gm in weight. The normal functioning of Thyroid Gland is essential for proper cardiac, pulmonary and neurological function of an individual

Thyroid hormones produced by thyroid gland are thyroxine (T4) and triiodothyronine (T3). The secretion of these two hormones is controlled by Thyroid Stimulating Hormone (TSH) which is produced by Pituitary Gland in brain.

Normal levels of thyroid hormones in plasma:

Thyroxine (T4) 5 - 12 micrograms / dl

Triiodothyronine (T3) 80 - 220 nanograms / dl

If these levels are low in a person, he or she is called as hypothyroid.

Normal levels of TSH in plasma:

Thyroid stimulating hormone (TSH) 0.4 to 0.5 milli units/L

If TSH is 5 to 10 milli units/ L, he or she has subclinical hypothyroidism

If TSH IS 18 milli units/L, he or she has moderate hypothyroidism

If TSH is 90 milli units/L, he or she has severe hypothyroidism

Symptoms and signs of hypothyroidism:

Slowing of mental and physical activity, slow speech, dry skin and dry hair, constipation, decreased sweating, cold intolerance, large tongue, deep hoarse voice, decrease in heart rate and cardiac output, abnormal heart rhythm, decreased response to hypoxia.

Potential Anaesthetic problems:

Hypothyroid patients develop increased sensitivity to

anaesthetic drugs like prolonged recovery due to reduced

cardiac output, higher incidence of cardiovascular instability

(low BP), decreased respiratory drive to hypoxia (reduction in

oxygen) and hypothermia (reduction in temperature).

They also pose airway related issues due to enlargement in

the neck ,swollen oral cavity and vocal cords.

Anaesthetic Options:

Regional anaesthesia is recommended if nature of surgery

permits.

If known hypothyroid patient, he should inform about condition,

duration of illness and thyroxin dosage to Anaesthetist prior to

surgery. Role of Anaesthetist in hypothyroid patients is very high

if they are posted for surgery, from entry to their comfortable

recovery and way back home with a warm smile. These values

may vary with age and should be interpreted by a Physician.

10 Health Tips to live Hundred YearsP.Muthu Lakshmi Department of Nursing

1. Keep your mind always positive to reduce your stress.

2. Do meditation for 100 hours per year (20 minutes/day).

3. Exercise & walking for 100 hours per year (20 minutes/day).

4. Maintain your fasting blood sugar level below 100 mgs/for Diabetic persons and random - <180 mgs.

5. Maintain your blood pressure 120/80 mmHg.

6. Avoid or reduce four whites in your diet.

1. Sugar. 2. Salt. 3. Butter 4. Rice.

7. Take green vegetables & natural colour fruits more in your diet and avoid non vegetarian food from 30 years onwards.

8. Add grains and pulses in your daily diet & drink 2-3 litres of water daily.

9. Maintain your normal weight i.e (Height -100) is ideal weight.

10. Avoid smoking & alcohol in your life.

Anaesthesia and Hypothyroidism

Dr.N.Premkumar Department of Anaesthesia

6

Vaccination does not end by childhood. One should know that it extends in to adolescent and adulthood period. So every individual should get vaccinated appropriately after getting doctor's opinion for continuous protection against vaccine preventable infection

recommended vaccines for Adolescents (10 Years to 18 Years)Indian Academy of Paediatrics

Tdap - used to prevent infection that cause Tetanus, Diphtheria, Pertusis.

Td - used to prevent infection that cause Tetanus, Diphtheria.

HPV Vaccine - used to prevent infection due to Human Papilloma Virus which causes cervical cancer in females.

Tdap preferred to Td, followed by repeat Td every 10 years (Tdap to be used once only) HPV - Only for females, three doses at 0, 1 or 2 (depending on the vaccine used) and 6 months

IAP Recommendations for Catch up (for those who did not get immunized earlier) Immunization in Adolescents

MMR – used to prevent infection that cause Mumps, Measles, Rubella.

Hepatitis A and Hepatitis B – used to prevent infection that cause jaundice.

Typhoid - used to prevent infection that causes Typhoid fever.

Varicella - used to prevent infection that causes Chicken Pox.

MMR one dose if previously vaccinated with one dose

** A minimum interval of 3 years should be observed between 2 doses of typhoid vaccine

IAP Recommendations for Catch up (for those who did not get immunized earlier) Immunization in Adolescents

Influenza Vaccine - used to prevent infection that cause flu / swine flu

Japanese Encephalitis Vaccine - used to prevent infection that cause brain fever

PPSV23 (Pneumococcal) Vaccine - used to prevent infection that cause brain fever and serious lung infection (Pneumonia)

Rabies Vaccine - used to prevent dog bite infection

Courtesy: IAP - Indian Academy of Paediatrics

IAP Recommendations for Adolescent Immunization in Special Circumstances

What's New ?

Any one above 30 years not already suffering from Diabetes, high blood pressure or Heart Disease can get themselves screened in the room near the Old Casualty Operation Theatre between 8.00 and 10 .00 AM on all working days for Blood Sugar, Blood Pressure and BMI. All are requested to utilise this facility.

NON COMMUNICABLE DISEASE SCREENING CENTRE

This new Electronic B.P Apparatus which gives accurate reading is available in selected O.P DS / Casualty and is being utilized by medical officers in these areas.

AUTOMATIC BP MONITORING APPARATUS

Dr.S.Bharathi Department of Paediatrics

Adolescent Vaccines

Vaccine Schedule

Tdap/Td 10 years

HPV 10 to 12 years

Vaccine Schedule

MMR 2 doses at 4-8 weeks interval

Hepatitis B 3 doses at 0, 1 and 6 months

Hepatitis A 2 doses at 0, 6 months

Typhoid 1dose every 3 years **

Varicella 2 doses at 4-8 weeks interval

Vaccine Schedule

Influenza Vaccine One dose every year.Japanese Encephalitis - Catch up - upto 15 years - Vaccine (Only in endemic area)

PPSV23 (Pneumococcal) Vaccine 2 doses 5 years apart

Rabies Vaccine 0, 3, 7, 14, 28 day As soon as possible after exposure

7

VITAMIN A

It is essential for normal vision, healthy skin and regulation of gene transcription.

Good sources are Carrot, Broccoli, Liver, Spinach, Egg, Cod Liver Oil, Milk and Tomatoes.

PROTEINS

It is required for growth and development of placenta.

Good sources are Legumes, Grains, Nuts, Meat, Poultry, Fish, Milk and Cheese.

OMEGA3 FATTY ACID

Required for brain development and to prevent pre term birth.

Good sources are Fish oil, fish and vegetable oil

FAT

Is essential for absorption for Vitamins like A, D, E and K

VITAMIN E-helps to protects cell membranes and as an anti-oxidant.

Good sources – Margarine, Wheat Germ and vegetable oil.

VITAMIN K

Helps wound healing and blood clotting mechanism.

Good sources – Green leafy vegetables.

VITAMIN B COMPLEX regulates variety of functions

Good sources – Cereals, Chicken, Fish, Potato, Liver, Yogurt, Egg Yolk, Green Leafy Vegetables, Cheese and Wheat.

In pregnancy, nutritional requirement is more on varied aspects.

Recommended weight gain in pregnancy is 11-14 kgs and is very appropriate for various changes in pregnancy for growing baby, placenta and uterus. Average caloric intake should be from 2400-2700 calories per day.

IMPORTANT NUTRIENTS IN PREGNANCY

FOLATE

It is required to reduce neural tube defects, foetal growth retardation, cleft lip, limb defects, congenital heart disease. It is ideal to start folic acid prior to conception.

Good sources are green leafy vegetables and fortified cereals.

IRON

Iron requirement increases for expanding maternal tissue including red cell mass. It is also required to compensate blood loss during delivery, to avoid low birth weight and pre term delivery.

Good sources are green leafy vegetables, fortified cereals, lean red meat, poultry, Jaggery.

CALCIUM

Pregnancy causes physiological decrease in albumin (a protein) which is needed for calcium transport. Calcium requirement increases during pregnancy.

Good sources are milk, dairy products, eggs, meat, fish

VITAMIN D

It helps the body to use calcium that is consumed and to maintain calcium and phosphorus levels.

Good sources are sunlight exposure, fish, milk, cereal, cheese and pork.

Dr.V.Sinduja Department of Obstetrics

Nutrition in Pregnancy

“EVERY ONE SHOULD EAT A HEALTHY, BALANCED DIET, BUT FOR PREGNANT WOMEN AND WOMEN WHO ARE TRYING TO CONCEIVE EATING TAKES ONE WHOLE NEW MEANING”.

Kudos...

Visit by Project Director, TANSACS

LIGNITE LIFE LINENews Letter of NLC General Hospital

(for private circulation only)Published by Neyveli Lignite Corporation Limited, ‘Navratna’ - A Govt. of India Enterprise

Neyveli 607 801, Tamil Nadu. Website : www.nlcindia.com

May 08, 2015 - Anaemia in CKD - Dr.Venkatesh, Consultant Nephrologist, Chennai

June 5, 2015 - Management of Shock in Paediatric Age Group - Dr.P.S.Rajakumar, Paediatric Intensivist, SRMCH, Chennai

April 17, 2015 - Chronic Myeloid Leukemia - Dr.Sunucyriac, Oncologist, JIPMER Hospital, Pondichery

NLC Raising Day was observed on 20.05.2015. On this occasion, company flag was hoisted by Dr.K.Janardhan, CGS/Medical. CGS/Medical solicited the sincere and prompt co-operation of all the doctors and staff of the hospital in providing quality medical care to all the patients.

Continuing to learn

May 12, 2015 – Hospital Management - Dr.Jeyamohandhass, RMO/NLC Hospital, Neyveli

NLC Raising Day - May 20, 2015